Volume 11 · Issue 07 · 2019

There are many reasons for abnormal blood glucose in clinic, among which secondary diabetes caused by endocrine diseases is common but easily overlooked. This article lists the characteristics of hyperglycemia caused by Cushing's syndrome, acromegaly, hyperthyroidism (hyperthyroidism) and central diseases, and introduces the main points of their diagnosis and treatment respectively. The treatment of secondary diabetes includes etiological treatment and hypoglycemic drug treatment. Reasonable hypoglycemic drugs should be selected according to different etiological causes, and the hypoglycemic regimen should be adjusted in time after the treatment of the primary disease.

Both type 1 and type 2 diabetes are at increased risk of fractures. However, the bone mineral densities in diabetic patients are not always declined, and diabetes therapies may also have various impacts on bone, thus leading to a clinical challenge on the management of the fracture risk in diabetes. After a full review of the most recent evidence, experts from Chinese Society of Osteoporosis and Bone Mineral Research, Chinese Society of Endocrinology, Chinese Diabetes Society, and Chinese Endocrinologists Association, Chinese Medical Doctor Association reached a consensus on several issues relating to how to evaluate fracture risk, when to initiate anti-osteoporosis therapies, and how to optimally use antidiabetic agents in diabetic patients.

The theory of continuous disease spectrum of diabetes was proposed in 2003, that is, all types of diabetes [from type 1 diabetes, high-titer adult occult autoimmune diabetes (LADA), low-titer LADA to type 2 diabetes] are presented as a continuous disease spectrum in general. It was subsequently confirmed by evidence such as islet function, immune status, inflammation level, metabolic characteristics, genetic background, etc. The creation of this theory reveals the reasons for clinical heterogeneity from the mechanism, makes multi-dimensional accurate typing possible from the diagnosis, provides guidance for formulating individualized plans from the treatment, and provides a basis for disease development and prognosis judgment from the prediction. However, at present, this theory has not included other special types of diabetes and gestational diabetes, so there are certain limitations, and it can't fully explain the heterogeneity of diabetes, so this theory still needs further improvement.

To investigate the characteristics and related risk factors of abnormal glucose metabolism in patients with Cushing′s disease.

A total of 154 patients who were hospitalized for Cushing′s disease in the Department of Endocrinology, Huashan Hospital affiliated to Fudan University from January 1st, 2013 to December 31st, 2017 were enrolled in this study. A retrospective method was used to analyze the prevalence of abnormal glucose metabolism in patients with Cushing′s disease. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICK) and Matsuda insulin sensitivity index (ISI Matsuda). β-cell function was evaluated by insulinogenic index (IGI)/HOMA-IR and insulin secretion-sensitivity index-2 (ISSI2). Spearman correlation analysis was used to investigate the relationship between cortisol level and insulin sensitivity or β-cell function. Logistic regression was used to analyze the possible factors associated with diabetes in patients with Cushing′s disease.

(1) Of these 154 patients with Cushing′s disease, 96(62.3%) were diagnosed as diabetes (DM group), while 32(20.8%) had prediabetes (preDM group). All of the preDM patients were impaired glucose tolerance. (2) The β-cell function evaluated by IGI/HOMA-IR and ISSI2 were lower in DM group than those in patients with normal glucose tolerance (NGT group) or preDM group. The IGI/HOMA-IR of NGT group, preDM group and DM group were 9.02(5.56, 12.53), 6.54(4.97, 8.79), 1.64(0.95, 3.31), respectively ( P<0.001). ISSI2 of the three groups were 30.43 (25.42, 38.63), 25.80 (20.87, 30.62), 11.90 (7.18, 16.62), respectively (P<0.001). (3) Logistic regression analysis showed that high blood cortisol level (OR=1.138, 95%CI: 1.070-1.211), high urinary cortisol level (OR=1.001,95%CI:1.001-1.002) and older age (OR=1.083, 95%CI:1.033-1.135) were risk factors of diabetes in patients with Cushing′s disease. (4) IGI/HOMA-IR was negatively correlated with blood cortisol level (00∶00) and 24 h urinary free cortisol level (r=-0.401,-0.260, respectively, all P<0.05). ISSI2 was negatively correlated with blood cortisol level (00∶00) and 24 h urinary free cortisol level (r=-0.397,-0.242, respectively, all P<0.05) too.

In patients with Cushing′s disease, higher blood cortisol level, higher urinary cortisol level and older age are risk factors for diabetes. Whether patients with Cushing′s disease develop diabetes is mainly associated with their β-cell function.

To explore the relationship between hyperandrogen and abnormal glucose tolerance (AGT) in women with polycystic ovary syndrome (PCOS), and to analyze the potential association between free androgen index (FAI) and insulin sensitivity/islet beta cell function.

Clinical data of 378 PCOS women including sex hormone and other parameters obtained by 75 g glucose tolerance test (OGTT) were retrospectively analyzed from Endocrinology Department of Drum Tower Hospital between April 2013 and March 2017. Free androgen index (FAI), 1/homeostasis model assessment of insulin resistance (1/HOMA-IR) index, Matsuda insulin sensitivity index (ISI_M), HOMA-β, InsAUC-30/GluAUC-30, InsAUC-120/GluAUC-120 and disposition index (DI) were calculated. Variance analysis or χ² test was used for comparison between groups. Bonferroni method was used for post hoc comparison. Multivariate logistic regression was used to analyze the relationship between FAI and AGT. Spearman correlation (corrected by age and body mass index) was used to analyze the relationship between FAI and insulin sensitivity index/β cell function.

Of 378 PCOS women, the mean age was (27.8±4.4) years, 59.8% (226 of 378) had normal glucose tolerance (NGT), 31.5%(119 of 378) had pre-diabetes, and 8.7% (33 of 378) had type 2 diabetes mellitus (T2DM). FAI in AGT [pre-diabetes 6.2(3.6, 10.3) and T2DM 7.9(4.4, 15.5)] were higher than those in NGT [5.0(2.8, 7.6), F=9.155, P<0.001]. FAI(OR: 1.166, 95%CI: 1.069-1.272) was an independent risk factor for AGT in women with PCOS. With the increase of FAI, insulin sensitivity [1/HOMA-IR, ISI_M and β cell function (DI-30, DI-120) decreased ( F=7.638, 6.863, 3.366, all P<0.05), while insulin secretion (HOMA-β, InsAUC-30/GluAUC-30 and InsAUC-120/GluAUC-120, DI-120) had a trend of increase, but the differences were not statistically significant (F=1.828, 1.315, both P>0.05).

High FAI levels are associated with high incidence of AGT, and FAI can be considered as an indicator of insulin resistance or β cell dysfunction in PCOS women.

To investigate the relationship between corneal nerve fibers and diabetic cardiac autonomic neuropathy (DCAN), and explore the early diagnosis of DCAN.

From September 2017 to March 2018, 62 inpatients with diabetes mellitus [28 males, 34 females, average age (57±13) years] and 20 healthy volunteers [8 males, 12 females, and average age (52±8) years] were enrolled. The Ewing test, 24 h dynamic electrocardiogram, and in vivo corneal confocal microscopy (IVCCM) were performed. According to Ewing test, diabetic patients were divided into DCAN group (n=30) and non-DCAN group (n=32). The differences of corneal nerve parameters between DCAN group, non-DCAN group and normal control group were compared. The correlation between corneal nerve parameters and Ewing test parameters and heart rate variability (HRV) parameters was analyzed. The diagnostic value of corneal nerve parameters for DCAN was evaluated by receiver operating characteristic (ROC) curve.

Corneal nerve parameters in the DCAN group were significantly lower than those in the non-DCAN group, while those in the non-DCAN group were significantly lower than those in the control group. After adjusting age, duration of disease, glycated hemoglobin A_1c and body mass index, corneal nerve parameters were significantly correlated with total Ewing score (r=-0.739--0.576, P=0.000) and deep breathing heart rate difference (r=0.284-0.442, P=0.000~0.013). CNFD was significantly correlated with HRV index (r=0.254-0.450, P=0.000-0.028). The area under the ROC curve of the corneal nerve parameters used to diagnose DCAN ranged from 0.890 to 0.939. The diagnostic sensitivity and specificity of CNFD and CNBD were above 80%.

The corneal confocal microscopy could promote the early diagnosis of DCAN. IVCCM is a useful supplement to DCAN diagnostic methods.

To explore the distribution characteristics of islet autoantibodies and other organ-specific autoantibodies in type 1 diabetes mellitus (T1DM) patients, and the correlation between organ-specific autoantibodies and clinical features.

A total of 205 newly diagnosed T1DM patients and 170 healthy controls were recruited in this study from the Second Xiangya Hospital of Central South University between Jan. 2015 and Dec. 2017. Glutamic acid decarboxylase antibody (GADA), insulinoma antigen 2 antibody (IA-2A), zinc transporter 8 antibody (ZnT8A) and other organ-specific autoantibodies, including thyroid peroxidase antibody (TPOA), thyroglobulin antibody (TGA), tissue transglutaminase antibody (tTGA) and 21-hydroxylase antibody (21-OHA) were detected by radioligand assay. In antibody-positive patients the function of thyroid and adrenal cortex was further examined; the coexistence of islet antibodies with other organ-specific autoantibodies, and the correlation between organ-specific antibodies and clinical characteristics were analyzed. Chi-square test, one-way analysis of variance and non-parametric test were used for statistical analysis.

(1) The positive rates of GADA, IA-2A and ZnT8A in patients with T1DM were significantly higher than those in healthy controls [70.2% (144/205) vs 0.6%(1/170), 42.9%(88/205) vs 0 and 30.7%(63/205) vs 0 (0/170), χ ²=190.131, 95.357, 62.792, respectively, all P<0.05]. (2) The positive rates of TPOA, TGA and 21-OHA in patients with T1DM were higher than those in healthy controls (24.9% vs 7.6%, 18.5% vs 5.9%, 2.9% vs 0, χ ²=19.493, 13.332, 3.375, respectively, all P<0.05). However, there was no significant difference in the positive rate of tTGA (P>0.05). (3) In T1DM patients the detections of combining various islet autoantibodies (GADA+IA-2A+ZnT8A) could increase the positive rate to 82.9%. (4) T1DM patients with positive GADA and IA-2A were more likely to have positive TPOA and TGA antibodies, patients with positive IA-2A were more likely to have positive tTGA antibodies, and patients with two or more islet autoantibodies were more likely to have positive TPOA and TGA antibodies. (5) The proportion of T1DM patients with Graves′ disease was higher than that of healthy controls (4.4% vs 0.6%, P<0.05).

T1DM patients are prone to merge other organ-specific autoantibodies. It is of great clinical significance to screen other organ specific autoantibodies, especially in T1DM patients with positive polyantibodies.

To evaluate the efficacy and safety of honey dressing in the treatment of diabetic foot ulcers (DFU).

Databases of PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang and VIP were searched to collect randomized controlled trials (RCT) about the honey dressing for DFU from database building to December, 2017. RevMan5.3 was used for data merge, Egger′s and Begg′s test were used for publication bias detection. GRADE profiler 3.6 was used for evidence grades assessment.

A total of 8 RCTs involving 767 patients with DFU were included in this study. The results showed that honey dressing was more favorable than control dressing in complete healing rate (RR=1.32, 95%CI: 1.10-1.57, P=0.003), mean healing time (SMD=-1.12, 95%CI: -2.06--0.19, P=0.02), percentage of healing (SMD=1.84, 95%CI: 0.27-3.42, P=0.02) and wound bacterial clearance rate (RR=2.56, 95%CI: 1.33-4.92, P=0.005), while there was no significant difference between these two groups in amputation rate (RR=0.55, 95%CI: 0.19-1.54, P=0.25). No serious side effects were reported in all of these studies. GRADE recommendation level is B grade, medium recommendation.

Honey dressing is a relatively safe and effective method in the treatment of DFU.

Many factors may influence the monitoring indicator of diabetes glycated hemoglobin (HbA_1c), abnormal hemoglobin changes are one of the important factors. In this study, a case of abnormal detection value found in clinical work was discussed. The abnormal specimens were detected by Tosoh G8 based on ion exchange high performance liquid chromatography and Capillary2 FP based on capillary electrophoresis. After the presence of variants was suggested, the mutation sites were further explored by polymerase chain reaction (PCR) and sequencing. The results showed that the detection value of Tosoh G8 was 2.9%, and the detection peak map of Capillary2 FP suggested that there was a relationship with HbA_1cPartially overlapping variant peaks, giving an alarm does not give a specific calculated value. The gene sequencing results confirmed that there was a mutation of lysine>asparagine at the amino acid position 59 of exon 2 of hemoglobin β chain gene in this sample, that is, AAG>AAC. This indicates that this sample is a rare case of hemoglobin J-Lome heterozygous variant, which can affect HbA_1cFor the detection of glycosylated albumin, it is recommended to monitor and evaluate blood glucose levels with other replacement indicators.

type 3c diabetes (T3cD), also known as pancreatic diabetes (according to the 2014 American diabetes Association classification), refers to diabetes secondary to pancreatic damage, including pancreatitis, pancreatic trauma, pancreatic tumors, pancreatic cystic fibrosis, hemochromatosis, etc., mainly characterized by damage to both pancreatic endocrine and exocrine glands^[1-2]。 In recent years, more and more patients have been diagnosed with T3cD, but the diagnostic criteria are not uniform, and it is easy to miss diagnosis and mistreatment. This article reviews and summarizes the latest research literature on epidemiological characteristics, pathogenesis, clinical characteristics, screening, diagnostic criteria and treatment of T3cD at home and abroad, hoping to attract clinicians' attention and promote the improvement of clinical diagnosis and treatment.

Photobiomodulation (PBM) is a therapeutic approach that exposes cells or tissues to low levels of laser light or light-emitting diodes, inducing photochemical reactions within cells to modulate cell activity. This article summarizes the application of PBM in diabetes from four aspects: inflammation, insulin resistance, diabetic complications and oxidative stress, and promotes the application of PBM in clinical treatment of diabetes and its complications. The feasibility of PBM in the treatment of human diabetes needs to be further studied, so as to reduce the complications in the treatment.

Glucokinase is an important glucose sensor in human body. It keenly senses the change of glucose concentration in the body, and starts different types of cells (β cells, α cells, intestinal L cells, etc.) involved in the blood glucose regulation system to release glucose-controlling hormones (insulin, glucagon, glucagon-1 receptor agonist, etc.), and acts on the liver to promote the synthesis or decomposition of liver glycogen, so that the glucose concentration is always maintained within the physiological blood glucose concentration range. It is through the action of glucokinase sensor that different cells and organs of the human body form a tightly regulated and stable glucose homeostasis network system, which always maintains the homeostasis of human blood sugar.